Systemic treatment in the management of head and neck cutaneous malignancies

For many advanced cutaneous malignancies, combined modality approaches with surgery, radiation, and systemic treatment with chemotherapy and/or biotherapy can maximize outcome for skin cancers of head and neck regions. Use of systemic therapies when given together or separately from radiation therapy, as the case may be, can often lead to better outcomes, with less overall morbidity and a higher likelihood of complete extirpative surgery. Good examples of this concept would be the use of concurrent chemoradiation for locally advanced squamous cell carcinoma of the skin, in which very large invasive tumors can be rendered dramatically smaller, if not completely gone. A novel oral biological drug that targets the Hedgehog signaling pathway, vismodegib, can shrink initially locally advanced unresectable basal cell carcinomas to a resectable, if not completely regressed, and hence curable state with the need for less aggressive and potentially disfiguring surgery. Adjuvant systemic therapies given after definitive surgery may also improve survival by reducing the likelihood of metastatic relapse in patients with aggressive melanoma or Merkel cell carcinoma. This review will provide further detail with regard to the use of some of the available systemic treatments for the common cutaneous malignancies of the head and neck, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, and Merkel cell carcinoma, to provide a better understanding of the multimodality approaches in these malignancies.